byFrank Ochberg, MD
Now that a major storm is headed toward the same regions that were battered last year, people face something called re-traumatization. What does that mean and what can we do about it?
Some of us are inoculated by trauma. We get a healthy dose and we have, essentially, a healthy response. As in the poem, Invictus, “… my head is bloody but unbowed.” We are tested and we meet the test – physically and emotionally. We are aware of our resilience and we face the next set of traumatic challenges with confidence.
Some of us get a dose of trauma and it is too much -or it comes when we are too young or too isolated or too occupied by other life stressors such as pregnancy, divorce, illness or poverty. We do not cope well. A looming second threat is not welcome. It causes fear and demoralization. It brings back unwanted memories of the first trauma.
Re-traumatization is the opening of old emotional wounds and the anxious anticipation of such re-wounding. It may be worse than the original trauma because it implies a string of “bad luck” – a sense of endless travail rather than one bad episode that has come and gone. It often feels like the old trauma plus a new trauma plus a loss of psychological safety. Psychological safety may be a myth (the thought that everything will eventually turn out right) but it is a helpful myth. It lets us live denying death. It saves us from the searing reality of biological truth.
Trauma therapists deal with re-traumatization all the time. In treating traumatic stress, we try to avoid opening a wound that is still too painful to be explored. Clumsy interviewing, bad timing, getting to a memory before rapport is developed – is bad therapy because it retraumatizes and destroys trust.
Courtroom procedures, insurance investigations and media interviews may re-traumatize. But information freely given and given under the right circumstances has been shown to help the healing process. Many survivors relish the chance to tell a trauma story.
When mother nature hurls a hurricane at the same survivors of last year’s storm, we can expect three negative effects among those most vulnerable:
1. Anticipatory anxiety will be high among those who were most emotionally damaged by the last hurricane. Instead of (or in addition to) post-traumatic stress disorder, they will have pre-traumatic stress disorder. This consists of dread, physical symptoms, concentration problems, insomnia and irritability.
2. Depression and demoralization can be expected throughout the hurricane’s advance and particularly if it strikes a severe blow. The symptoms include helplessness, worthlessness, hopelessness and lethargy.
3. PTSD (post-traumatic stress disorder) can combine elements of the last hurricane with images, sounds and fears associated with the current storm. Treatment will have to include attention to both sets of traumatic events.
So how do we best prepare for the emotional impact?
First, we recognize who is at risk. We try to de-stigmatize conversations among family members, students, friends and co-workers so that those who will have a likelihood of disabling symptoms are not burdened with excessive responsibility and are given the help they need.
Second, we identify those who are emotionally resilient and we enlist their aid in doing more, understanding more, and picking up the slack. We must be very careful about assuming we can handle stress disorders if we cannot. This is a time for honest self-appraisal.
Third, we set up systems to help the helpers. Most relief agencies have learned a lot about secondary traumatic stress, compassion fatigue, vicarious victimization and doing what is needed when helping hurts the helper. See www.ptsdinfo.org for articles and resources.
When my patients call, sometimes years later, to describe a recurrence of PTSD, they usually feel unlucky, unable to cope, and they say, “I’m back to square one.” It’s as though all they learned about overcoming traumatic stress has vanished. The cause is usually a second trauma, but it may be a physical illness or a prolonged misfortune that falls short of the kind of trauma that causes PTSD. I review the progress they made before this happened. I search with them for sources of self-confidence. I remind them of their skills in surviving and coping. And I let them know that PTSD is real and it cannot be wished away. They may need more therapy. They may need medication, but I never assume that. They always need understanding and supportive friends.
Journalists can help communities cope by identifying resources for those who are at risk, and by emphasizing coping strategies that help individuals and groups weather storm after storm after storm. Life is storm after storm after storm, with calm days in between.